Borderline Personality Disorder is a mental health condition where a person finds it difficult to regulate their emotion. People experiencing BPD feel emotions intensely and for sustained periods of time. It becomes difficult for them to return to a stable baseline after they have experienced an event that has emotionally triggered them.
The condition is characterized by impulsivity, poor self-image, stormy relationships, and intense emotional response to stressors. Attempting to self-regulate can have dangerous behavioral results like self-harming (cutting, burning). An estimated 1.6% of the adult US population suffers from Borderline Personality Disorder. The statistic could be as high as 5.9%. About 75% of the individuals diagnosed with the condition are women. Men tend to be misdiagnosed with PTSD or depression.
Symptoms of Borderline Personality Disorder
Individuals with Borderline Personality Disorder are inclined to experience wide mood swings. They may also exhibit a deep-seated sense of instability and insecurity. Symptoms for diagnosing BPD as per the Diagnostic and Statistical Manual diagnostic framework are-
- Rushed efforts to avoid abandonment, whether real or imagined, by friends and family.
- “Splitting,” that is, alternating between idealization and devaluation in personal relationships.
- Distortion of self-image that has an impact on moods, values, goals, opinions, and relationships.
- Dangerous and reckless behavior such as unprotected sex, substance abuse, excessive spending and so on.
- Suicidal threats, attempts, and other such self-harming behavior.
- Periods of irritability, anxiety or intense depression that may last between hours and days.
- Chronically feeling emotionally empty.
- Anger outbursts that are inappropriate, intense or uncontrollable – usually followed by shame and guilt.
- Paranoid thoughts related to stress and dissociative feelings where an individual disconnects from their thoughts, sense of identity, and expresses having “out of body” feelings. Brief psychotic episodes can result from extreme stress.
Causes of Borderline Personality Disorder
Although the exact causes of Borderline Personality Disorder have still not been determined, scientists believe that it results from a combination of factors such as-
- Genetics – No specific gene or gene profile has been identified to directly cause BPD. However, studies that have been made on twins have suggested strong hereditary links in its occurrence. A first-degree relative with the disorder predisposes you to be five times as likely to develop it.
- Environmental factors – If you happen to have experienced traumatic life events early on in your childhood, such as physical/sexual abuse or neglect and separation from parents, you stand at an increased risk of developing the condition.
- Brain function – There may be a neurological basis for some of the symptoms associated with BPD as the emotional regulation system may be different in people with BPD. The part of the brain that controls decision-making/judgment and emotions may not optimally communicate with each other in a person with BPD.
Diagnosing Borderline Personality Disorder
Borderline Personality Disorder cannot be diagnosed with any definitive medical test. Its diagnosis is also not based on any single sign or symptom. A mental health professional can diagnose BPD after a comprehensive clinical interview which may include consulting previous clinicians, going through previous medical evaluations and even interviews with friends and family wherever appropriate.
Treatment for Borderline Personality Disorder
An effective treatment plan should address any co-existing conditions that you may have and include your preferences at the same time. Treatment options for Borderline Personality Disorder may include psychotherapy, medication, group/peer/family support. Primarily, the goal of the treatment is to encourage a person with BPD to self-direct their treatment plan by themselves as they come to learn what works effectively and what doesn’t. Below are some of the ways BPD can be treated:
- Psychotherapy – The first line of choice for Borderline Personality Disorder treatment is dialectical behavioral therapy(DBT), cognitive behavioral therapy(CBT), and psychodynamic psychotherapy. Learning methods which help cope with emotional dysregulation in a therapeutic setting can bring effective long-term improvement for those who experience BPD.
DBT teaches the individual coping skills that battle counter-productive urges, control emotions, and improve relationships as a result. It encourages the use of mindfulness techniques such as self-soothing, meditation, and regulated breathing. It has been found to be effective in the reduction of suicidal behavior, psychiatric hospitalization, substance abuse, treatment dropout, interpersonal difficulties, and anger.
CBT helps the patient recognize negative thoughts and learn coping strategies to combat them.
Mentalization-based Therapy(MBT) tries to teach people to be conscious of their internal states and develop empathy for the experiences of others.
- Medications – There is no medicine that can specifically treat the core symptoms of BPD. Various symptoms related to the condition are treated with various medications. Mood stabilizers and antidepressants work for dysphoria and mood swings. Antipsychotic medication in low dosages can be prescribed for some people to treat disorganized thinking. Medication can help a person with BPD engage better in their psychotherapy sessions.
- Short-term hospitalization – Extreme stress, impulsive/suicidal behavior may warrant a stay in the hospital for the patient’s own safety.
Conditions Related to Borderline Personality Disorder
Borderline Personality Disorder can be extremely difficult to diagnose and treat as a person experiencing BPD may also report experiencing additional conditions such as Anxiety Disorders, PTSD, Depression, Bipolar Disorders, Substance Abuse, and Eating Disorders.
Borderline Personality Disorder Care
Most people with Borderline Personality Disorder can live in the community during their treatment. However, some individuals may require increased care which is when intensive clinical support can help. An actively suicidal person with BPD can benefit from the safe environment of a hospital inpatient unit.
The DBT framework urges a person to acquaint himself/herself with the necessary coping skills while in the community. Inpatient care is usually not required. There are facilities that have a DBT track in an inpatient-partial hospital program, that is, a model which allows you to sleep at home and attend during the day. The level of care you or your loved one may require should be determined importantly before engaging in treatment.
Borderline Personality Disorder Self-care
Effective treatment can go a long way in helping you deal with your Borderline Personality Disorder. Here are some other ways you can try as well:
- Find emotional support by connecting with others suffering from BPD.
- Eat well, exercise, and meditate to cope with stress.
- Stay away from drugs and alcohol as they can disturb the emotional balance and react with your medication.
Surround yourself with friends and family. Allow them to help in whichever way they can. You do not have to fight the disease alone!